if the Affordable Care Act is repealed by Congress, two major hspital groups expect to see emergency rooms flooded by uninsured patients, causing catastrophic losses. (Photo by Joe Raedle/Getty Images

Hospitals across the country are bracing for a financial apocalypse if President-elect Donald Trump and the Republican congress repeal the Affordable Care Act (ACA), also known as ObamaCare. Two hospital groups spelled out the details in a new report.

The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) today (Dec. 6) sent letters to Trump and Congressional leaders calling attention to the report. It details the impact, if an estimated 20 million people lose health insurance coverage.

“Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses,” according to Rick Pollack and Chip Kahn, president and chief executive of the AHA and FAH respectively.

Specifically, the groups are seeking support for the restoration of the Medicare hospital inflation update, as well as Medicare and Medicaid Disproportionate Share Hospital (DSH) funding.

Those revenues were cut when the ACA passed. It was anticipated that hospitals would require less funding because the number of uninsured patients was expected to decline.

The most recent Republican repeal without replacement bill, (H.R. 3762), would slam hospitals with $165.8 billion in losses between 2018 and 2026, according to the report. That’s assuming that Medicaid DSH cuts are restored under the bill, which the groups said was “absolutely essential.”

Hospitals would suffer a loss of $289.5 billion in Medicare inflation updates if the payment reductions in the ACA are not restored. Failing to restore the ACA’s Medicare and Medicaid DSH reductions would amount to $102.9 billion in losses, the study said.

The impact of repealing the ACA will go beyond just the delivery of hospital services.

“Hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced,” the study said.

Pollack and Kahn urged lawmakers to have another plan ready to go should they repeal the ACA to “guarantee similar coverage to those who would lose it.”

The report, commissioned by the AHA and FAH, was prepared by the health care economics firm Dobson | DaVanzo.

The hospital executives also noted that hospitals have been saddled with an additional $148 billion of cuts between 2010 and 2026 through other congressional and executive branch actions.

The executives added:

“We strongly believe that any repeal legislation must be accompanied by provisions that protect the coverage for those currently receiving such protection. However, if that is not the legislative path to be pursued, then it is vital that such legislation provide a true clean slate and also include repeal of the reductions in payments for hospitals services embedded in the ACA – specifically the substantial reductions to hospitals’ annual inflation updates and the cuts to Medicare and Medicaid DSH payments. If the coverage associated with the ACA disappears, the importance of these payments would be heightened – they are vital in helping defray the costs of treating our most vulnerable patients.”

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the improvement of health in their communities

The FAH, founded in 1966, is the national representative of more than 1,000 investor-owned or managed community hospitals and health systems throughout the United States.

A copy of the executive summary and full study can be found by visiting here.

Keith Girard has 30 years of experience as an award-winning reporter, editor-in-chief, and senior media executive. Keith’s career began in Washington, D.C., where he was a reporter for The Washington Post and a contributing editor for Regardie's and Washingtonian magazines. He also worked as a writer/producer in CNN's Washington Bureau and has written one book on the U.S. Marines in the Gulf War.